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image of Reported Postoperative Surgical Site Infections in Tertiary Care Hospitals, Systematic Review of Recent Literature

Abstract

Purpose

The objective of this systematic review is to evaluate the patterns of post-surgical site infections, pre-surgical antibiotics prophylaxis, and related clinical outcomes in the recently published literature.

Methods

This systematic review is registered with PROSPERO registration number CRD42023398963. Several databases and individual journal websites were used to collect data from PubMed/Medline, TRIP, SCOPUS, Elsevier, Springer, ProQuest, and EMBASE. The established criteria of inclusion were RCTs, retrospective, prospective, and cross-sectional studies with patients who had a recent surgical procedure. Excluded from the study designs were systematic reviews, prospective studies, data on pediatrics, and data on disabilities. Quality assessment analysis of the results for randomized controlled trials (RCT) used CONSORT guidelines and STROBE guidelines for cross-sectional and cohort studies.

Results

A total of 328 articles were identified from different databases. Among them, 15 studies were included for data extraction and qualitative analysis. A total of 33,193 patients with an average rate of 11.5% (surgical site infections- SSIs) were identified in these studies during 2008-2022. The mean rate of SSIs among the total number of immunocompromised patients/procedures was 10.2%. The SSI on patients undergoing major surgical procedures with visible incisions was 26.0%. The majority of the studies reported the use of pre-surgical antibiotic prophylaxis. Cefazolin was mostly prescribed antibiotics and administered in 90% of patients. Other antibiotics included ceftriaxone (4%), cloxacillin (3%), and vancomycin (4%). The mean reported rate of SSIs with combination antibiotic prophylaxis therapy was 22.8%.

Conclusion

This systematic review concluded the limited reported data on surgical site infections (SSIs). The overuse of pre-surgical antibiotic prophylaxis has been reported in several studies. This study recommended developing standardized guidelines on the use of antibiotics related to surgical cases rather than co-morbidities.

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2025-01-28
2025-07-07
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References

  1. Magill S.S. Edwards J.R. Bamberg W. Beldavs Z.G. Dumyati G. Kainer M.A. Lynfield R. Maloney M. McAllister-Hollod L. Nadle J. Ray S.M. Thompson D.L. Wilson L.E. Fridkin S.K. Multistate point-prevalence survey of health care-associated infections. N. Engl. J. Med. 2014 370 13 1198 1208 10.1056/NEJMoa1306801 24670166
    [Google Scholar]
  2. Mawalla B. Mshana S.E. Chalya P.L. Imirzalioglu C. Mahalu W. Predictors of surgical site infections among patients undergoing major surgery at Bugando Medical Centre in Northwestern Tanzania. BMC Surg. 2011 11 1 21 10.1186/1471‑2482‑11‑21 21880145
    [Google Scholar]
  3. Owens C.D. Stoessel K. Surgical site infections: Epidemiology, microbiology and prevention. J Hosp Infect 2008 70 Suppl 2 3 10 10.1016/S0195‑6701(08)60017‑1
    [Google Scholar]
  4. Emori T.G. Gaynes R.P. An overview of nosocomial infections, including the role of the microbiology laboratory. Clin. Microbiol. Rev. 1993 6 4 428 442 10.1128/CMR.6.4.428 8269394
    [Google Scholar]
  5. Cooper R.A. Surgical site infections: Epidemiology and microbiological aspects in trauma and orthopaedic surgery. Int. Wound J. 2013 10 s1 Suppl. 1 3 8 10.1111/iwj.12179 24251837
    [Google Scholar]
  6. de Lissovoy G. Fraeman K. Hutchins V. Murphy D. Song D. Vaughn B.B. Surgical site infection: Incidence and impact on hospital utilization and treatment costs. Am. J. Infect. Control 2009 37 5 387 397 10.1016/j.ajic.2008.12.010 19398246
    [Google Scholar]
  7. Fortun J. Martin-Davila P. Pascual J. Cervera C. Moreno A. Gavalda J. Aguado J.M. Pereira P. Gurguí M. Carratala J. Fogueda M. Montejo M. Blasco F. Bou G. Torre-Cisneros J. Immunosuppressive therapy and infection after kidney transplantation. Transpl. Infect. Dis. 2010 12 5 397 405 10.1111/j.1399‑3062.2010.00526.x 20553437
    [Google Scholar]
  8. Drugs that delay wound healing. Prescrire Int. 2013 22 137 94 98 23662318
    [Google Scholar]
  9. Esposito S. Immune system and surgical site infection. J Chemother 2001 13 Spec No 1 1 12 16 10.1179/joc.2001.13.Supplement‑2.12
    [Google Scholar]
  10. Coccolini F. Improta M. Cicuttin E. Catena F. Sartelli M. Bova R. de’ Angelis N. Gitto S. Tartaglia D. Cremonini C. Ordonez C. Baiocchi G.L. Chiarugi M. Surgical site infection prevention and management in immunocompromised patients: A systematic review of the literature. World J. Emerg. Surg. 2021 16 1 33 10.1186/s13017‑021‑00375‑y 34112231
    [Google Scholar]
  11. Balakirski G. Kotliar K. Pauly K.J. Krings L.K. Rübben A. Baron J.M. Schmitt L. Surgical site infections after dermatologic surgery in immunocompromised patients: A single-center experience. Dermatol Surg 2018 44 12 1525 1536
    [Google Scholar]
  12. Balakirski G. Löser C.R. Dippel E. Surgical site infections after microscopically controlled skin surgery in immunocompromised patients: A retrospective two-center cohort study. Arch Dermatol Res 2020 312 491 499
    [Google Scholar]
  13. Scanlon M.M. Gazelka H.M. Moeschler S.M. Hoelzer B.C. Hooten W.M. Bendel M.A. Lamer T.J. Surgical site infections in cancer patients with intrathecal drug delivery devices: Table 1. Pain Med. 2016 18 3 pnw203 10.1093/pm/pnw203 27550951
    [Google Scholar]
  14. PROSPERO. 2023 Available from: https://www.crd.york.ac.uk/prospero/#recordDetails
  15. Page M.J. McKenzie J.E. Bossuyt P.M. Boutron I. Hoffmann T.C. Mulrow C.D. Shamseer L. Tetzlaff J.M. Akl E.A. Brennan S.E. Chou R. Glanville J. Grimshaw J.M. Hróbjartsson A. Lalu M.M. Li T. Loder E.W. Mayo-Wilson E. McDonald S. McGuinness L.A. Stewart L.A. Thomas J. Tricco A.C. Welch V.A. Whiting P. Moher D. The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. BMJ 2021 372 71 n71 10.1136/bmj.n71 33782057
    [Google Scholar]
  16. STROBE. 2023 Available from: https://www.strobe-statement.org/
  17. Mitt P. Lang K. Peri A. Maimets M. Surgical-site infections following cesarean section in an Estonian university hospital: Postdischarge surveillance and analysis of risk factors. Infect. Control Hosp. Epidemiol. 2005 26 5 449 454 10.1086/502566 15954482
    [Google Scholar]
  18. Jain A.K. Patidar H. Nayak V. Agrawal R. Prevalence, risk factors and microbial profile of surgical site infection after cesarean section in a tertiary care center in Western India. J. Pure Appl. Microbiol. 2022 16 1 700 707 10.22207/JPAM.16.1.73
    [Google Scholar]
  19. Koumu M.I. Jawhari A. Alghamdi S.A. Hejazi M.S. Alturaif A.H. Aldaqal S.M. Surgical site infection post-appendectomy in a tertiary hospital, Jeddah, Saudi Arabia. Cureus 2021 13 7 e16187 10.7759/cureus.16187 34367794
    [Google Scholar]
  20. García Prado M.E. Matia E.C. Ciuro F.P. Díez-Canedo J.S. Sousa Martín J.M. Porras López F.M. de la Casa Á.C. Cisneros Herreros J.M. Surgical site infection in liver transplant recipients: Impact of the type of perioperative prophylaxis. Transplantation 2008 85 12 1849 1854 10.1097/TP.0b013e3181735407 18580480
    [Google Scholar]
  21. Petrosillo N. Drapeau C.M.J. Nicastri E. Martini L. Ippolito G. Moro M.L. Surgical site infections in Italian hospitals: A prospective multicenter study. BMC Infect. Dis. 2008 8 1 34 10.1186/1471‑2334‑8‑34 18328101
    [Google Scholar]
  22. Eckmann C. Kramer A. Assadian O. Flessa S. Huebner C. Michnacs K. Muehlendyck C. Podolski K.M. Wilke M. Heinlein W. Leaper D.J. Clinical and economic burden of surgical site infections in inpatient care in Germany: A retrospective, cross-sectional analysis from 79 hospitals. PLoS One 2022 17 12 e0275970 10.1371/journal.pone.0275970 36576894
    [Google Scholar]
  23. Asensio A. Ramos A. Cuervas-Mons V. Cordero E. Sánchez-Turrión V. Blanes M. Cervera C. Gavalda J. Aguado J.M. Torre-Cisneros J. Effect of antibiotic prophylaxis on the risk of surgical site infection in orthotopic liver transplant. Liver Transpl. 2008 14 6 799 805 10.1002/lt.21435 18508358
    [Google Scholar]
  24. Pongbangli N. Oniem N. Chaiwarith R. Nantsupawat T. Phrommintikul A. Wongcharoen W. Prevalence of Staphylococcus aureus nasal carriage and surgical site infection rate among patients undergoing elective cardiac surgery. Int. J. Infect. Dis. 2021 106 409 414 10.1016/j.ijid.2021.03.024 33737131
    [Google Scholar]
  25. Aisu N. Tanimura S. Yamashita Y. Yamashita K. Maki K. Yoshida Y. Sasaki T. Takeno S. Hoshino S. Impact of perioperative probiotic treatment for surgical site infections in patients with colorectal cancer. Exp. Ther. Med. 2015 10 3 966 972 10.3892/etm.2015.2640 26622423
    [Google Scholar]
  26. Kasatpibal N. Jamulitrat S. Chongsuvivatwong V. Standardized incidence rates of surgical site infection: A multicenter study in Thailand. Am. J. Infect. Control 2005 33 10 587 594 10.1016/j.ajic.2004.11.012 16330307
    [Google Scholar]
  27. Maksimović J. Marković-Denić L. Bumbaširević M. Marinković J. Vlajinac H. Surgical site infections in orthopedic patients: Prospective cohort study. Croat. Med. J. 2008 49 1 58 65 10.3325/cmj.2008.1.58 18293458
    [Google Scholar]
  28. Harrington G. Russo P. Spelman D. Borrell S. Watson K. Barr W. Martin R. Edmonds D. Cocks J. Greenbough J. Lowe J. Randle L. Castell J. Browne E. Bellis K. Aberline M. Surgical-site infection rates and risk factor analysis in coronary artery bypass graft surgery. Infect. Control Hosp. Epidemiol. 2004 25 6 472 476 10.1086/502424 15242194
    [Google Scholar]
  29. Dellinger Ep. Ehrankarns N.J. Surgical infections, in hospital infection 1998
    [Google Scholar]
  30. Nguyen T.A. Rowe G. Harris K. Ko S. Ko M. Gharavi N.M. Antibiotic use and surgical site infections in immunocompromised patients after mohs micrographic surgery: A single-center retrospective study. Dermatol. Surg. 2022 48 12 1283 1288 10.1097/DSS.0000000000003620 36449868
    [Google Scholar]
  31. Ronin E. Derancourt C. Cabié A. Marion-Sanchez K. Achromobacter spp. Surgical site infections: A systematic review of case reports and case series. Microorganisms 2021 9 12 2471 10.3390/microorganisms9122471 34946073
    [Google Scholar]
  32. Awadh H. Mansour M. Aqtash O. Shweihat Y. Pneumonia due to a Rare Pathogen: Achromobacter xylosoxidans, Subspecies denitrificans. Case Rep. Infect. Dis. 2017 2017 1 4 10.1155/2017/3969682 28894613
    [Google Scholar]
  33. Moro M.L. Morsillo F. Tangenti M. Mongardi M. Pirazzini M.C. Ragni P. Rates of surgical-site infection: An international comparison. Infect. Control Hosp. Epidemiol. 2005 26 5 442 448 10.1086/502565 15954481
    [Google Scholar]
  34. Marion-Sanchez K. Pailla K. Olive C. Le Coutour X. Derancourt C. Achromobacter spp. healthcare associated infections in the French West Indies: A longitudinal study from 2006 to 2016. BMC Infect. Dis. 2019 19 1 795 10.1186/s12879‑019‑4431‑3 31500579
    [Google Scholar]
  35. Harrop J.S. Styliaras J.C. Ooi Y.C. Radcliff K.E. Vaccaro A.R. Wu C. Contributing factors to surgical site infections. J. Am. Acad. Orthop. Surg. 2012 20 2 94 101 10.5435/00124635‑201202000‑00005 22302447
    [Google Scholar]
  36. Young B. Ng T.M. Teng C. Ang B. Tai H.Y. Lye D.C. Nonconcordance with surgical site infection prevention guidelines and rates of surgical site infections for general surgical, neurological, and orthopedic procedures. Antimicrob. Agents Chemother. 2011 55 10 4659 4663 10.1128/AAC.00562‑11 21825293
    [Google Scholar]
  37. McDonald M. Grabsch E. Marshall C. Forbes A. Single- versus multiple-dose antimicrobial prophylaxis for major surgery: A systematic review. Aust. N. Z. J. Surg. 1998 68 6 388 395 10.1111/j.1445‑2197.1998.tb04785.x 9623456
    [Google Scholar]
  38. Harbarth S. Samore M.H. Lichtenberg D. Carmeli Y. Prolonged antibiotic prophylaxis after cardiovascular surgery and its effect on surgical site infections and antimicrobial resistance. Circulation 2000 101 25 2916 2921 10.1161/01.CIR.101.25.2916 10869263
    [Google Scholar]
  39. De Chiara S. Chiumello D. Nicolini R. Vigorelli M. Cesana B. Bottino N. Giurati G. Caspani M.L. Gattinoni L. Prolongation of antibiotic prophylaxis after clean and clean-contaminated surgery and surgical site infection. Minerva Anestesiol. 2010 76 6 413 419 20473254
    [Google Scholar]
  40. Misha G. Chelkeba L. Melaku T. Incidence, risk factors and outcomes of surgical site infections among patients admitted to Jimma medical center, South West Ethiopia: Prospective cohort study. Ann. Med. Surg. 2021 65 102247 10.1016/j.amsu.2021.102247 33898031
    [Google Scholar]
  41. Banashankari G S Rudresh H K Harsha SS An overview of surgical site infections: An insight into the prevalence, etiology and predisposing factors. Int. J. Med. Sci. Clin. Inven. 2014 1 9
    [Google Scholar]
  42. Lilani S.P. Jangale N. Chowdhary A. Daver G.B. Surgical site infection in clean and clean-contaminated cases. Indian J. Med. Microbiol. 2005 23 4 249 252 10.1016/S0255‑0857(21)02530‑5 16327121
    [Google Scholar]
  43. Afifi I.K. Labah E.A. Ayad K.M. Surgical site infections after elective general surgery in Tanta University Hospital: Rate, risk factors and microbiological profile. Egypt. J. Med. Microbiol. 2009 18 2 61 72
    [Google Scholar]
  44. Lebo N.L. Quimby A.E. Caulley L. Thavorn K. Kekre N. Brode S. Johnson-Obaseki S. Surgical site infection affects length of stay after complex head and neck procedures. Laryngoscope 2020 130 12 E837 E842 10.1002/lary.28512 31977071
    [Google Scholar]
  45. Mujagic E. Marti W.R. Coslovsky M. Soysal S.D. Mechera R. von Strauss M. Zeindler J. Saxer F. Mueller A. Fux C.A. Kindler C. Gurke L. Weber W.P. Associations of hospital length of stay with surgical site infections. World J. Surg. 2018 42 12 3888 3896 10.1007/s00268‑018‑4733‑4 29978247
    [Google Scholar]
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